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MYCOPHENOLATE MOFETIL IN THE TREATMENT OF PRIMARY GLOMERULONEPHRITIS Chow YW, Yahya R, Visvanathan R Department of Nephrol...
Objective Patients with primary glomerulonephritis (GN)  Steroids or Cytotoxic agents Treatment resistance Frequent relapses
Objective <ul><li>Mycophenolate mofetil (MMF) in addition to its immunosuppressive effects </li></ul><ul><ul><li>Inhibit v...
Design & Methods   Four patients   Focal Segmental Glomerulosclerosis (FSGS)  Membranous nephropathy (MN)  3 1 Partial Res...
Design & Methods <ul><li>MMF dose range  </li></ul><ul><ul><li>   1.5-3.0g daily </li></ul></ul><ul><ul><li>   at least ...
Definitions <ul><li>Complete remission </li></ul><ul><li>Urinary protein excretion less than  0.3g/24hours and </li></ul><...
Definitions <ul><li>Progressive renal impairment </li></ul><ul><li>Rise in serum creatinine > 50umol/l or </li></ul><ul><l...
Results <ul><li>Mean age of 37.23  +  19.72 years  </li></ul>Telmisartan 80mg dly Enalapril 10mg dly 4 - Enalapril 20mg BD...
Results 1 - Membranous GN 2 1 FSGS Partial Remission Complete remission
Results- 24 hour Urine Protein 24 hour urine protein: 7.58  +  10.10 to 0.91  +  0.94g/24 hours (p=0.03)
Results- Serum Albumin Serum albumin: 18  +  10.49 to 39  +  4.25g/L (p=0.71)
Results- Serum Cholesterol Serum cholesterol: 11.38  +  1.72 to 5.15  +  1.07mmol/l (p=0.46)
Results- Serum Creatinine Serum Creatinine: 183.75  +  63.93 to 127.50  +  38.20umol/l  (p=0.68)
Results- eGFR eGFR: 38.76  +  16.25 to 56.52  +  18.81mls/min/1.73m2 (p=0.68)
Results- Adverse Events <ul><li>Two patients were hospitalized  </li></ul><ul><ul><li>Herpes zoster infection  </li></ul><...
Conclusion <ul><li>MMF could be useful in treatment of FSGS and MN. It appears to be well tolerated. Its efficacy requires...
Discussion Clinical Trials on MMF in FSGS
CR-1, NR-1 12 1.0-2.0 2 Tasanatong J Ass Med Thai, 06’ CR-5, PR-16, R-7, NR14 43 TOTAL CR-1. NR-1 6-8 1.5 2 Tang,  J Nephr...
Discussion Clinical Trials on MMF in Membranous Nephropathy
CR-2, PR-9 R-3, NR-2 , NA-1 4-25 1.5-2.0 17 Choi,  KI  02’ CR-3, PR-13, R-9, NR-10 36 TOTAL PR-2, R-6, NR-8 8 0.5-2.0 16 M...
 
 
 
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Mycophenolate Mofetil in Primary Glomerulonephritis

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Dr Chow Yok Wai
MSN 2007
Kuala Lumpur

Published in: Health & Medicine, Business
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Mycophenolate Mofetil in Primary Glomerulonephritis

  1. 1. MYCOPHENOLATE MOFETIL IN THE TREATMENT OF PRIMARY GLOMERULONEPHRITIS Chow YW, Yahya R, Visvanathan R Department of Nephrology, Kuala Lumpur Hospital
  2. 2. Objective Patients with primary glomerulonephritis (GN) Steroids or Cytotoxic agents Treatment resistance Frequent relapses
  3. 3. Objective <ul><li>Mycophenolate mofetil (MMF) in addition to its immunosuppressive effects </li></ul><ul><ul><li>Inhibit vascular smooth muscle cell </li></ul></ul><ul><ul><li>Mesangial cell proliferation </li></ul></ul><ul><li> Ameliorate inflammation </li></ul><ul><li> Slow the progression in glomerular disease </li></ul><ul><li>We report our experience in using MMF for the treatment of primary GN. </li></ul>
  4. 4. Design & Methods Four patients Focal Segmental Glomerulosclerosis (FSGS) Membranous nephropathy (MN) 3 1 Partial Response to Steroids and Cyclosporine Steroid Resistance No Response to Steroids and Cyclophosphamide 1 2 1
  5. 5. Design & Methods <ul><li>MMF dose range </li></ul><ul><ul><li> 1.5-3.0g daily </li></ul></ul><ul><ul><li> at least 6 months </li></ul></ul><ul><li>24 hour urine protein </li></ul><ul><li>Serum albumin, </li></ul><ul><li>Serum creatinine, </li></ul><ul><li>Estimated GFR (eGFR) and </li></ul><ul><li>Serum cholesterol </li></ul><ul><ul><li>Start, 1, 3 and 6 months after MMF therapy were compared. </li></ul></ul>
  6. 6. Definitions <ul><li>Complete remission </li></ul><ul><li>Urinary protein excretion less than 0.3g/24hours and </li></ul><ul><li>Normal serum albumin (>30g/L) and </li></ul><ul><li>Improved or stable renal function </li></ul><ul><li>Partial remission </li></ul><ul><li>Urinary protein excretion reduced by > 50% with range of 0.3-3.0g/24hours and </li></ul><ul><li>Serum albumin > 30g/L </li></ul>
  7. 7. Definitions <ul><li>Progressive renal impairment </li></ul><ul><li>Rise in serum creatinine > 50umol/l or </li></ul><ul><li>Decrease in creatinine clearance exceeding 15% of baseline </li></ul><ul><li>Treatment failure </li></ul><ul><li>Persistent urinary protein excretion > 3g/24hours or </li></ul><ul><ul><ul><li>Progressive renal impairment within 12 months of starting therapy or </li></ul></ul></ul><ul><li>Permanent discontinuation of therapy as a result of drug side effects. </li></ul>
  8. 8. Results <ul><li>Mean age of 37.23 + 19.72 years </li></ul>Telmisartan 80mg dly Enalapril 10mg dly 4 - Enalapril 20mg BD 3 Irbesartan 300mg dly Perindopril 8mg dly 2 Telmisartan 80mg dly Enalapril 20mg BD 1 ARB ACEI Patient
  9. 9. Results 1 - Membranous GN 2 1 FSGS Partial Remission Complete remission
  10. 10. Results- 24 hour Urine Protein 24 hour urine protein: 7.58 + 10.10 to 0.91 + 0.94g/24 hours (p=0.03)
  11. 11. Results- Serum Albumin Serum albumin: 18 + 10.49 to 39 + 4.25g/L (p=0.71)
  12. 12. Results- Serum Cholesterol Serum cholesterol: 11.38 + 1.72 to 5.15 + 1.07mmol/l (p=0.46)
  13. 13. Results- Serum Creatinine Serum Creatinine: 183.75 + 63.93 to 127.50 + 38.20umol/l (p=0.68)
  14. 14. Results- eGFR eGFR: 38.76 + 16.25 to 56.52 + 18.81mls/min/1.73m2 (p=0.68)
  15. 15. Results- Adverse Events <ul><li>Two patients were hospitalized </li></ul><ul><ul><li>Herpes zoster infection </li></ul></ul><ul><ul><li>(10 days and 5 weeks after MMF initiation). </li></ul></ul>
  16. 16. Conclusion <ul><li>MMF could be useful in treatment of FSGS and MN. It appears to be well tolerated. Its efficacy requires validation in randomized, controlled trials. </li></ul>
  17. 17. Discussion Clinical Trials on MMF in FSGS
  18. 18. CR-1, NR-1 12 1.0-2.0 2 Tasanatong J Ass Med Thai, 06’ CR-5, PR-16, R-7, NR14 43 TOTAL CR-1. NR-1 6-8 1.5 2 Tang, J Nephro 05’ CR-0, PR-8, NR-10 6 2.0 18 Cattran, Clin Neph 04’ CR-1, PR-1 12 2.0 2 Day, NDT 02’ CR-2, PR-6 R-7, NR-2 NA-1 4-24 1.5-2.0 18 Choi, KI 02’ PR 21 2.0 1 Choi, AJKD 98’ Outcome F/up (mths) MMF Dose n
  19. 19. Discussion Clinical Trials on MMF in Membranous Nephropathy
  20. 20. CR-2, PR-9 R-3, NR-2 , NA-1 4-25 1.5-2.0 17 Choi, KI 02’ CR-3, PR-13, R-9, NR-10 36 TOTAL PR-2, R-6, NR-8 8 0.5-2.0 16 Miller, AJKD 00’ PR-2 CR-1 8-10 1.5-2 3 Choi, AJKD 98 Outcome F/up (mths) MMF Dose (g/day) n

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